Layout 1 ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution- Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ISDS 2012 Conference Abstracts SMART Platforms: Building The App Store for Biosurveillance Kenneth D. Mandl* 1Boston Children’s Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA Objective To enable public health departments to develop “apps” to run on electronic health records (EHRs) for (1) biosurveillance and case re- porting and (2) delivering alerts to the point of care. We describe a novel health information technology platform with substitutable apps constructed around core services enabling EHRs to function as iPhone-like platforms. Introduction Health care information is a fundamental source of data for bio- surveillance, yet configuring EHRs to report relevant data to health departments is technically challenging, labor intensive, and often re- quires custom solutions for each installation. Public health agencies wishing to deliver alerts to clinicians also must engage in an endless array of one-off systems integrations. Despite a $48B investment in HIT, and meaningful use criteria re- quiring reporting to biosurveillance systems, most vendor electronic health records are architected monolithically, making modification difficult for hospitals and physician practices. An alternative approach is to reimagine EHRs as iPhone-like platforms supporting substi- tutable apps-based functionality. Substitutability is the capability in- herent in a system of replacing one application with another of similar functionality. Methods Substitutability requires that the purchaser of an app can replace one application with another without being technically expert, with- out requiring re-engineering other applications that they are using, and without having to consult or require assistance of any of the ven- dors of previously installed or currently installed applications. Apps necessarily compete with each other promoting progress and adapt- ability. The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project is funded by a $15M grant from Office of the National Coordinator of Health Information Technology’s Strategic Health IT Advanced Research Projects (SHARP) Program. All SMART standards are open and the core software is open source. The SMART project promotes substitutability through an applica- tion programming interface (API) that can be adopted as part of a “container” built around by a wide variety of HIT, providing read- only access to the underlying data model and a software development toolkit to readily create apps. SMART containers are HIT systems, that have implemented the SMART API or a portion of it. Contain- ers marshal data sources and present them consistently across the SMART API. SMART applications consume the API and are substi- tutable. Results SMART provides a common platform supporting an “app store for biosurveillance” as an approach to enabling one stop shopping for public health departments—to create an app once, and distribute it everywhere. Further, such apps can be readily updated or created—for example, in the case of an emerging infection, an app may be designed to col- lect additional data at emergency department triage. Or a public health department may widely distribute an app, interoperable with any SMART-enabled EMR, that delivers contextualized alerts when patient electronic records are opened, or through background processes. SMART has sparked an ecosystem of apps developers and at- tracted existing health information technology platforms to adopt the SMART API—including, traditional, open source, and next genera- tion EHRs, patient-facing platforms and health information ex- changes. SMART-enabled platforms to date include the Cerner EMR, the WorldVista EHR, the OpenMRS EHR, the i2b2 analytic platform, and the Indivo X personal health record. The SMART team is work- ing with the Mirth Corporation, to SMART-enable the HealthBridge and Redwood MedNet Health Information Exchanges. We have demonstrated that a single SMART app can run, unmodified, in all of these environments, as long as the underlying platform collects the re- quired data types. Major EHR vendors are currently adapting the SMART API for their products. Conclusions The SMART system enables nimble customization of any elec- tronic health record system to create either a reporting function (out- going communication) or an alerting function (incoming communication) establishing a technology for a robust linkage be- tween public health and clinical environments. Keywords Electronic health records; Biosurveillance; Informatics; Application Programming Interfaces Acknowledgments This work was funded by the Strategic Health IT Advanced Research Projects Award 90TR000101 from the Office of the National Coordina- tor of Health Information Technology. *Kenneth D. Mandl E-mail: kenneth_mandl@harvard.edu Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e32, 2013